Investigations and Initial Management
Bloods on admission were unremarkable other than an acute kidney injury with a creatinine of 136µmol/L from a baseline of 68µmol/L. Computerised tomography of his abdomen and pelvis with intravenous contrast showed herniation of several bowel loops, the prostate gland and the entire bladder into the right hemiscrotum causing obstructive uropathy (see figure). He was catheterised with some difficulty and had a residual volume of 2000ml. Following discussion with the patient and his family regarding definitive management of the hernia, a joint decision was made to treat conservatively. He remained clinically stable and was subsequently discharged home with long-term catheter in situ.